Provider Demographics
NPI:1801950712
Name:MEREDITH, RANDALL MILLER (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MILLER
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 13TH ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2700
Mailing Address - Country:US
Mailing Address - Phone:706-722-3401
Mailing Address - Fax:706-724-6540
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:SUITE 20
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2700
Practice Address - Country:US
Practice Address - Phone:706-722-3401
Practice Address - Fax:706-724-6540
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050821207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA715601961AMedicaid
GAI41993Medicare UPIN
GA715601961AMedicaid